[Question #5908] Am I at risk?

19 months ago
Hello, thanks for the amazing work you guys do.
4ays ago I had protected vaginal and unprotected oral sex with a fsw in Argentina also we kissed, the problem is that she began giving me oral with a condom under my request and then we began to have vaginal sex in which I couldnt maintain the erection, then she started to give me oral again and once I had the erection we tried vaginal again, this happened like 3 times, while she was giving me oral the condom slip off completely and I told her to continue with the oral, at some point I gave up and ended it there, I couldnt finish. 
As far as I remember the condom never slip off completely while I was inside or outside her while maintaining vaginal sex, I'm pretty sure that the head was always covered and also I'm circumcised.
I check the condom with water up to the middle of it and there was no leaking.
1. Could my loose of erection made me more susceptible to hiv even tho it always covered the head?
2. Is there a way that the condom slip off while inside her and got back in place?
3. I started to take sertraline a day before the encounter and I am currently taking it, could that medication maximize the risk of infection in case she was positive, like lowering my defenses?
4. Would you had put me in PEP following this encounter?
5. Do you recommend testing from this specific encounter?
6. I dont have hsv1  what are the chances that she passed it to my genitals? I didnt notice any sores in her mouth or genitals.
7. Can I go back to unprotected sex with my partner?
So far I didnt notice anything weird in my gentinal or mouth
Thank you in advance.
19 months ago
Just to clarify the condoms did slip off, just not entirely to the point of uncovering the penis head
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
Welcome to the forum. Thanks for your question and your confidence in our services.

The first thing to know is that the large majority of female sex workers, in Argentina and elsewhere, do not have HIV. That she used a condom for oral sex -- which most FSWs know is low risk compared with vaginal or anal sex -- suggests she is among the careful ones who takes care to protect herself. Second, when a woman has HIV, the average risk of HIV transmission from vaginal sex is around once for every 2,500 events. So even if you had entirely unprotected sex (successfully), your risk of HIV from this event would have been very low. Given that the exposure was largely condom protected lowers the risk still further. When the penis remains in the condom, it's fair to assume a high degree of protection.

Those comments partly address your questions, but to be explicit for each of them:

1. Maybe a little more susceptible, but the risk was low anyway. The loose condom probably makes no significant difference.

2. I'm an STD/HIV expert, not an expert on the mechanics of sex or condoms. But it seems to me very unlikely your penis entirely exited the condom and then got back in. Don't you agree?

3. No medications are known to elevate the risk of HIV if exposed. I see no reason to suspect sertraline would do that.

4. PEP decisions depend on the knowledge of a local expert. If local data show that HIV is particularly common in FSWs in her particular neighborhood or place of work, perhaps PEP would be recommended. But even then, probably not given the mostly protected nature of the exposure.

5. Testing for HIV is optional in this situation. The risk is low enough that it probably isn't necessary. On the other hand, whenever someone is nervous enough to come to a forum like this, testing usually is wise. Many persons in your situation will be more reassured by a negative test than by scientific and statistical analysis, no matter how expert the source. If that applies to you, by all means get tested.

6. The risk of genital HSV1 in this circumstance, even without a condom, probably is under 1 chance in tens of thousands. With a condom, it's zero risk. Don't worry about it.

7. Sex with your regular partner is a judgment call that only you can make. If I were in your situation, I would continue sex with my wife and would not be tested for HIV or any other STD. But i'm not you. I can assure you the risk you have anything is extremely low, but I cannot say it is zero.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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19 months ago
Thank you for your answer, so just to clarify, if I went to you with this sexual experience, you would not give me PEP is that right?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
See my answer to question no. 4 above. Most likely I would not have recommended PEP, but I can imagine scenarios in which it would be reasonable. In any case, you're now beyond the 72 hour window for starting PEP, so it's a moot point.---
19 months ago
Just for information to understand how transition works, if the women is more wet, does that mean that the hiv virus is more concentrated than if she is not? And last question. Have you ever seen someone getting hiv from a single exposure like mine where the head of the penis was always covered and beign circumcise? Thank you for your responses
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
The amount of pre-sexual lubricating fluid ("more wet" or not) isn't known to make any difference in STD/HIV risk. Why does that even come to mind? There is no science that suggests it. 

To my knowledge, I have never had a patient who acquired HIV in such cirumstances.

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been informative and reassuring, as it was meant to be. 
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